BMC Journal of Medical Sciences

Male Infertility: Its Diagnosis and Management

Mohammad Shoaib Khan — 2024-07-03

Male infertility is a significant health issue affecting couples worldwide. Male infertility, a complex and increasingly prevalent issue, poses significant challenges to reproductive health both nationally and internationally. Traditionally infertility has been considered female concern, but recent studies highlighted that male factor contributes equally to fertility problems in couples. Male infertility is a significant medical condition affecting approximately 7% of men worldwide, with approximately 50% of infertility cases attributed to male factors. It is defined by the inability to conceive a child after one year of unprotected intercourse. There are different causes of male infertility, which can vary widely and may include hormonal imbalances, genetic factors, anatomical issues such as varicocele (enlarged veins within the scrotum), or lifestyle factors such as smoking or excessive alcohol consumption. Diagnosis and management strategies play crucial roles in addressing this condition and improving fertility outcomes. Diagnosis typically involves semen analysis to assess sperm count, motility, and morphology. Treatments range from medication to surgery, depending on the underlying cause, although in some cases, assisted reproductive techniques like in vitro fertilization (IVF) may be necessary ^1.

It is reported that Trace minerals play a crucial role in male fertility by supporting various physiological processes necessary for sperm production and function. Zinc, for instance, is essential for the synthesis of testosterone and the development of healthy sperm. Deficiencies in zinc have been linked to decreased sperm quality and infertility in men². Selenium is another trace mineral that acts as an antioxidant, protecting sperm from oxidative damage and enhancing sperm motility. Adequate intake of these traces minerals through diet or supplementation may potentially improve fertility outcomes in men by supporting sperm health and function.³

According to WHO, Accurate diagnosis of male infertility involves a comprehensive evaluation of both medical history and physical examination, followed by specialized laboratory tests. Conventional method of Semen analysis remains the cornerstone for assessing male fertility, examining parameters such as sperm count, motility, and morphology ⁴. Additional tests may include hormonal assays to assess levels of testosterone, follicle-stimulating hormone (FSH), and luteinizing hormone (LH), which provide insights into testicular function and endocrine status⁵.

Advanced diagnostic techniques are also available in specialized fertility centers such as sperm DNA fragmentation testing and sperm function assays, which have gained importance in recent years for evaluating sperm quality beyond traditional parameters ^6. Similarly, Genetic testing may also be indicated in cases of suspected genetic abnormalities impacting fertility, such as Y chromosome micro deletions or karyotyping analysis ^7.

Male infertility can be better managed, if the underlying cause is properly identified through diagnostic evaluation. It is reported that lifestyle modifications, including weight management, smoking cessation, and reduction of alcohol intake, may improve sperm quality in some cases⁸. Beside this, Medical interventions such as hormone replacement therapy or medications to improve sperm production (e.g., clomiphene citrate) can be beneficial for certain hormonal imbalances ^9.

Moreover, assisted reproductive techniques (ART), including intrauterine insemination (IUI) and in vitro fertilization (IVF) with intracytoplasmic sperm injection (ICSI), are often employed when natural conception is not achievable¹⁰. These techniques offer viable options for couples facing male infertility, particularly in cases of severe sperm abnormalities or obstruction of the reproductive tract. Despite advancements, challenges however, still persist in managing male infertility, which includes access to specialized care centre and financial constraints related to ART.

It is concluded that effective management of male infertility requires a multidisciplinary approach, involving urologists, reproductive endocrinologists/ andrologists, pathologists, and genetic counselors. Collaborative efforts between clinicians, researchers and policymakers are also beneficial to address the complexities of male infertility and hence enhance overall fertility care. Early and accurate diagnosis enables targeted interventions that can significantly improve fertility outcomes for couples. Continued research and technological advancements are crucial for enhancing diagnostic precision and therapeutic efficacy in addressing male infertility.

References:

Mayo Clinic. (2024). Male infertility. Retrieved from https://www.mayoclinic.org/diseases-conditions/male-infertility/symptoms-causes/syc-20374773.
Khan, M. S., Zaman S., Sajjad M., Shoaib M., & Jilani G. Assessment of the level of trace element zinc in seminal plasma of males and evaluation of its role in male infertility. IJABMR. 2011; 1(2):93-96.
National Institutes of Health. (2021). Office of Dietary Supplements - Zinc. Retrieved from https://ods.od.nih.gov/factsheets/Zinc-HealthProfessional/
World Health Organization. (2010). WHO laboratory manual for the examination and processing of human semen (5th ed.). Geneva: World Health Organization.
Jequier, A. M., & Chanson, A. (2015). Hormonal aspects of male infertility. In E. Nieschlag, H. M. Behre, & S. Nieschlag (Eds.), Andrology: Male reproductive health and dysfunction (3rd ed., pp. 409-431). Berlin: Springer-Verlag.
Evenson, D. P., & Wixon, R. (2006). Clinical aspects of sperm DNA fragmentation detection and male Theriogenology, 65(5), 979-991.
Krausz, C. (2011). Male infertility: Pathogenesis and clinical diagnosis. Best Practice & Research Clinical Endocrinology & Metabolism, 25(2), 271-285.
Showell, M. G., et al. (2014). Lifestyle factors affecting sperm morphology, sperm DNA integrity, and the implications for male infertility. In S.H. Swan (Ed.), Seminars in reproductive medicine (Vol. 32, 4, pp. 229-238). New York: Thieme Medical Publishers.
Guay, A. T., et al. (2003). Clomiphene increases free testosterone levels in men with both secondary hypogonadism and erectiledysfunction: Who does and does not benefit? International Journal of Impotence Research, 15(3), 156-165.

Palermo, G. D., et al. (1992). Intracytoplasmic sperm injection: A novel treatment for all forms of Male factor infertility. Fertility and Sterility, 55(2), 443-450.

Elective Surgery Patients Satisfaction towards Perioperative Service and its Associated Factors at Amhara region comprehensive Specialized Hospitals of Ethiopia

Yabibal Asfaw Derso — 2024-07-03

Abstract

Background: Patient satisfaction is considered one of the desired outcomes of health care and is directly related to the utilization of health services. Satisfaction with care is vital in determining whether a person seeks medical advice, complies with treatment, and maintains a continuing relationship with health care providers.

Objective: The aim of this study was to assess elective surgery patient satisfaction with perioperative service and its associated factors at comprehensive specialized hospitals in the Amhara region, Ethiopia.

Material and Methods: A cross-sectional study design was used from April 15 to May 15, 2023 on a sample of 383 elective surgery patients using systematic random sampling technique. Data was collected using structured quationary and Data was analyzed by SPSS version 25.

Results: The questionnaire was administered to a total of 383 elective surgery patients of which 64% were male, about 23.2%, 62.4% were from the rural residence, and 53.5% of the study subjects had paid for treatment. Overall, elective surgery patients' satisfaction with perioperative service was 62.1%. According to our findings, payment status for treatment (p=0.001), patient residence (p=0.00), Educational status (p=0.000), operated on the agreed date and time (p= 0.000), and expectation of service (P=0.017) were all found to be statistically significant predictors of elective surgery patient satisfaction with perioperative service.

Conclusion: Compared to others previous studies, the overall prevalence of elective surgery patients satisfied with perioperative service was good. Elective surgery patient satisfaction with perioperative service was significantly influenced by patient residence, operated on agreed date and time, payment status for treatment, patient expectations for service, and the patient's educational level.

Helicobacter Pylori Infection and its Associated Factors Among Adult Clients Attending out-Patient Department in Shashemene Comprehensive Specialized Hospital, Shashemene Town, Southern Ethiopia

Motuma Amenu — 2024-07-03

Abstract

Background: Helicobacter pylori infection is a major public health problem with 50% of the global population infected. Millions of people develop the peptic ulcerative disease in their lifetime and many may progress into gastric cancer. It is endemic to developing countries, including Ethiopia.

Objective: To assess the prevalence of H. pylori infection & its associated factors among dyspeptic & non-dyspeptic

adult Clients.

Materials and Methods: A cross-sectional institutional study involving 423 adult clients attending OPD at Shashemene Comprehensive Hospital was conducted from March 3 to April 15, 2021. Data for risk factors were assessed through a structured questionnaire. About 50 mg fresh stool and 1ml of total venous whole blood sample were taken for H. pylori antigen using Wondfo feces test kit & blood, respectively. Data were analyzed by SPSS of version 22. Both bivariate and multivariable logistic regression analyses were carried out to identify the significant variable with a cut-off p-value of less than 0.05.

Results: A total of 423 participants were interviewed giving a response rate of 100%. The mean (± SD) age of respondents was 35.6 (± 10.75) years. The magnitude of H. Pylori infection among participants was 26.7% with 95%CI (22.9, 31.2). Participants who had no formal education (AOR=3.25, CI 95% =1.49-7.04), alcohol consumption (AOR=4.54, CI 95%= 2.41-8.52), family size with ≥6 siblings (AOR= 6.14, CI 95% = 3.21-11.74), dyspepsia (AOR=2.34, CI 95% =1.18-4.61), uncooked food consumption (AOR=2.89, CI 95% =1.24-6.76), and highly perceived stress level participant (AOR= 8.87, CI 95% = 3.95-9.93) were significantly associated with H. Pylori infection

Conclusion: The overall prevalence is high in the study area, where one in four patients were being infected. The study showed significant association of different factors mentioned in results, The results also indicated that the bacterium is common in healthy individuals and is still a public health concern that needs further investigation by future researchers.

Causes of Primary Versus Secondary Infertility in Women Undergoing Diagnostic Laparoscopy

Shahzadi Saima Hussain — 2024-07-03

Abstract

Background: Infertility is defined as failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse,. This study was planned to compare the frequency of different causes of infertility undergoing diagnostic laparoscopy and chromopertubation.

Objective: To compare the frequency of different causes of infertility in women with primary and secondary infertility undergoing diagnostic laparoscopy

Material and Methods: This study was a five-year retrospective observational study conducted in Lady Reading Hospital from January 2017 to December 2021. Data record of all patients who underwent diagnostic laparoscopy and chromopertubation for infertility was retrieved. Basic demographic features like age, type of infertility (primary or secondary) and duration of infertility were noted in all patients. During the procedure, any abnormal features of the uterus, ovaries, and fallopian tubes including patency, uterosacral ligaments, Pouch of Douglas, and any adhesions or endometriosis were also noted. Findings were recorded on proforma.IBM SPSS Version 22.0 was used for data analysis

Results: In this study, we got a record of 1945 patients, n=1427 (71.9%) patients had primary infertility while n=518 (26.1 %) had secondary infertility, mean age was 29.73± 4.37. Regarding causes of infertility, abnormal findings in fallopian tubes were more common in patients with secondary infertility (31.46% versus 23.05% of cases of primary infertility),an ovarian abnormality was observed in 16.88% in primary versus 22.58 in secondary infertility, endometriosis was seen in 27.99% of cases of secondary infertility in comparison to 22.42% in primary infertility, fibroid uterus was noted in 11.5% of primary infertility and 8.5 % of cases of secondary infertility.

Conclusion: Tubal pathology and endometriosis are the most frequent abnormalities found in patients with secondary infertility, and uterine abnormalities are more common in patients with primary infertility.

Comparison of Various Factors Related to Severity of Ischemic Stroke in Patients with and Without Good Glycemic Control

Faiqa latif — 2024-07-03

Abstract

Background: Stroke medicine is an evolving speciality under the umbrella of neurology. It not only covers the neuropathological impact of stroke but provide holistic care to these patients for early recovery with minimum disability.

Objective: To compare various factors related to severity of ischemic stroke in patients with and without good glycemic control managed at our Neurology/Medicine Department

Material and Methods: In this comparative cross-sectional study, carried out at the Department of Neurology/Medicine, Pak Emirates Military Hospital Rawalpindi. From September 2022 to December 2022. Out of 100 patients of acute ischemic stroke suffering from diabetes mellitus was included. Patients of ischemic stroke with confirmed diagnosis on neuroimaging were recruited. Severity of stroke by NHSS classification and size of infarct on CT scan was assessed for all the study participants. Glycosylated hemoglobin was performed on all patients and patients were classed as having glycemic control or not. On the basis of this investigation, stroke severity parameters were compared in groups with and without glycemic control.

Results: In the study. Male were 66 (66%) , while 34 (34%) were female. Mean age of patients of stroke recruited in analysis was 56.31 ±8.18 years. Out of total, 44 (44%) patients had glycemic control while 56 (76.25%) had no glycemic control. Statistical analysis revealed that when comparison was made among two groups, more stroke severity and infarct size of more than 50 ml were seen statistically significantly more in patients who did not have glycemic control (p-value<0.001).

Conclusion: Poor or no glycemic control was seen in almost half of the patients who presented with ischemic stroke. More stroke severity and large size of infarct were seen in patients without glycemic control in our study participants.

Reverse Posterior Interosseous Artery Flap for Hand Defects

Asad Ullah Jan — 2024-07-03

Abstract

Background: Soft tissue defects in hand needs an early reconstructive procedure that is single stage and well vascularized for best functional outcomes. Usually flap coverage is required for joints, exposed bones and long tendons. When local flaps are inadequate for the required defects, regional flaps are used.

Objective: The study was designed to evaluate the outcome of reverse posterior interosseous artery flap for hand soft tissue defects.

Material and Methods: This is a retrospective chart review of patients from 2013 to 2019 at National Orthopedic Hospital at Bahawalpur and was compiled at DHQTH, Bannu in 2023. During this time, 45 cases of posterior interosseous artery flap meeting the inclusion criteria were included in this study.

Results: In 34 cases the defect was due to crush, in 6 blast injury and in 5 thermal injury. Male to female ratio was 9:1. The defect was mostly on dorsum of hand and first web space. In all the cases, split thickness skin graft was used to cover the donor site. Three (7 %) patients had superficial flap necrosis at the distal most part, for which debridement and skin grafting was done.

Conclusion: Reverse posterior interosseous artery flap is an excellent source of skin coverage of dorsal hand and 1st web space.

Pre-Operative Value of X-Ray Chest in Patients Undergoing Elective General Surgeries

Mujahid Raza — 2024-07-03

ABSTRACT

Background: Imaging evaluation of patients undergoing general surgeries is routinely done pre-operatively. The indications of radiographic evaluation are only for acute nature of complication. However, sometimes all elective and acute general surgery patients undergo a chest x-ray. Unnecessary exposure of radiation is a significant health threat.

Objective: This study aimed to assess role of pre-operative chest radiographs in patients undergoing general surgeries.

Material and Methods: This retrospective analysis was conducted at the department of Radiology, Pakistan Institute of Medical Sciences, Islamabad spanned over a period of 15 months from October 2021 to January 2023. A total of 7850 adult patients were included. Record of patients coming for x-ray chest from other departments than the general surgery was excluded. Administrative permission was taken from head of department and a verbal consent was taken from patients/caregivers before x-ray. All x-ray films were reported by a senior radiologist. Data were entered and analyzed in SPSS-22.

Results: The mean age was 45.8 ± 11.6 years with a male predominance with 4632 (59.1%). There were 528 (6.7%) cases with positive findings while the remaining 7322 (93.2%) were negative. It was noted that 273 (3.59%) had apical plural thickening, while 105 (1.31%) had right upper lobe fibrosis. Other frequent findings were left upper lob fibrosis 32 (0.41%), blunting of right CP angle 31 (0.40%), blunting of left CP angle 62 (0.79%).

Conclusion: The study found out that more than 90.0% of chest-rays were normal and a very few 7.2% were found abnormal.

Disparities in Epilepsy Knowledge, Beliefs and Cost-Effectiveness: A Comparative Analysis of Rural Healthcare Facilities in Bhakkar Hard- to-Reach District in South Punjab- Pakistan

Muhammad Haseeb — 2024-07-03

ABSTRACT

Background: Although 80% of the 50million people with epilepsy reside in resource poor, developing countries. Epilepsy care in these regions remains limited and the majority of epilepsy patients go untreated due to various modifiable and non-modifiable factors.

Objective: Comparing the effectiveness of volunteer specialist intervention versus autonomous epilepsy treatment to optimize care strategies and improve patient well-being in rural areas of Bhakkar, Punjab, Pakistan.

Material and Methods: An observational study comparing treatment gap and expenses between two cohorts: one being supported and treated at Rukhsana Shafqat Medical Centre, and their counterpart’s getting treatment from other facilities with spending out of their pocket was carried out June 01, 2023 to January 01, 2024 at RSMC Bhakkar, Punjab.

Results: A comparison of 100 epilepsy cases each from a major medical center (RSMC) and rural healthcare facilities shows demographic and clinical differences. RSMC patients are younger, with different gender ratios and education levels. RSMC reports 31% idiopathic epilepsy, 61% symptomatic, and 8% cryptogenic, contrasting rural centers' 14%, 78%, and 8%. Co morbidities vary, with 49 individuals having none in RSMC and 60 in rural centers. Treatment duration and disease knowledge also differ, with RSMC demonstrating better knowledge (64.57% good knowledge) compared to rural centers (52.63%). Misconceptions are higher in rural areas (50.4%) than at RSMC (36%). Monthly costs are predominantly below 5000 PKR at RSMC (87%) and in 72% of cases in rural centers, with 28% spending more than 5000 PKR.

Conclusion: The community-based rehabilitation model of care can offer an alternative approach to epilepsy care and address the reality of most people with epilepsy living in such areas of poor developing countries.

Comparison of Bilateral Lateral Rectus Recession Vs Unilateral Recession/Resection for Basic Type Intermittent Exotropia

Hamid Ur Rehman — 2024-07-03

Abstract:

Background: Intermittent exotropia (IXT), highly prevalent strabismus type in children, characterized by visual axis intermittent divergence. It can cause greater than 50% of all the exotropia cases. Because of different deviation at near and at a distance, IXT can be grouped as Basic, Pseudo-divergence excess, true distance and insufficiency of convergence. The most common is basic exotropia.

Objective: To compare post-operative ocular alignment in bilateral lateral rectus recession (BLR) Vs unilateral lateral rectus recession/resection (RR) in basic type intermittent exotropia in young patients.

Material and Methods: 96 cases of basic intermittent exotropia who went through surgery were selected. Total duration of study was 18 months from January 2020 to June 2021. The patients were categorized into BLR group and unilateral RR group based on type of surgery received. Based on motor outcomes, patients were categorized as: 1) successful alignment (Orthophoria) Esophoria/tropia< 10 Prism diopters to Exophoria/tropia< 15 Prism diopters.2) Overcorrection (Esophoria/tropia>10 Prism diopters) 3) Under-correction/recurrence (Exophoria/tropia> 15 Prism diopters). Surgical outcome including motor criteria and sensory status compared at post-operative 03, 06, 09 and 12 months between groups.

Results: The mean age at the time of surgery was 12.68 ± 8.12yrs. for BLR and 13.88 ± 8.34yrs. for RR group. The rate of successful alignment was 70.83% (n= 34) for BLR group and 58.33% (n=28) for RR group at final follow-up visit (p=0.200). At 03 months, RR had better alignment rate while BLR had superior outcome at 06-, 09- and 12-months’ follow-up visits. The secondary outcome i.e. stereopsis recovery rate was also comparable between the two groups at final follow-up of 12 months (p-value= 0.159).

Conclusion: The motor outcomes in BLR group were comparable to RR group at the final follow-up visit.

The rates of under-correction were higher in RR group (though not statistically significant) at 12th month visit.

Conventional Cytogenetic Analysis of Females with Primary Amenorrhea

Atif Ahmad Khan — 2024-07-03

Abstract

Background: Primary amenorrhea, characterized by the absence of menstrual periods in females of reproductive age, presents a multifaceted challenge in clinical practice. Cytogenetic analysis stands as a foundational pillar in unraveling the genetic landscape governing primary amenorrhea.

Objective: The study was designed to determine the chromosomal abnormalities of females with primary amenorrhea.

Materials and Methods: In the current cross-sectional study, two hundred patients with a history of primary amenorrhea were processed by the standard KAROTYPING technique. The study was carried out at the Molecular genetics/cytogenetic department, chughtai institute of pathology, Lahore, Pakistan for a period of one year from July-2020 – July-2021.

Result: In the present study, a total of 200 female patients were included. Among these 200 patients, 80 exhibited chromosomal abnormalities. Specifically, there were 50 (62.5%) cases with 46, XY, 10 (12.5) cases with 45, X, 10 (12.5) cases with iso, Xq, 7 (8.7%) cases with XY del, and 3 (3.7) cases with mosaic Turner syndrome. Notably, the predominant clinical features included the development of breast in 51% of cases, hirsutism in 61% of cases, and pubic hair development in 7% of cases. Ultrasound reports revealed that 19.3% of patients had a normal uterus, 51.4% had a small uterus, and 20.2% were devoid of a uterus, as indicated in Table 1, along with other hormonal values.

Conclusion: The present study provides a nuanced understanding of chromosomal abnormalities in females with primary amenorrhea. The identification of diverse anomalies, along with their associated clinical features and uterine morphology, contributes valuable information to the existing literature. The comparison with previous studies underscores both consistencies and novel findings, emphasizing the evolving landscape of knowledge in the field of reproductive genetics. Further research is warranted to explore the implications of these chromosomal variations for clinical management and genetic counseling in females with primary amenorrhea.

Vaccination Status in Children presenting with severe complicated Measles

Kalim Ullah — 2024-07-03

ABSTRACT

Background: Measles occurs worldwide and remains a leading cause of mortality especially among children ≤5 years of age. Present study will determine this association in our local population.

Objective: The aim of the study was to determine the frequency of unvaccinated children in patients presenting with severe Measles.

Material and Methods: After permission from Hospital ethical committee. Total 145 patients of severe measles were enrolled, and frequency of unvaccinated children was noted. This study was conducted in Children Ward, Women & Children Hospital, MTI Bannu from October 2022 to April 2023. The results obtained were presented in the form of tables and graphs and level of significance was determined statistically.

Results: In our study, total 145 patients were enrolled. Mean age of patients was 7.07±2.3 years. Minimum age was 3 years and maximum age was 12 years. There were 46.2% males and 53.8% female patients. Most of patients belonged to middle socioeconomic status i.e. 57.2. Regarding maternal education 50.3% were having 6-10 years of education, 20.9% had less than 5 years of education, 16.6% had 11-12 years of education while only 4.1% had more than 12 years of education. In our study participants 47.6% lived in urban area and 52.4% lived in rural area. There were 66.2% unvaccinated children and 33.8% were vaccinated. Data stratification for age group, BMI, residential status and socioeconomic status was significant i.e. p-value≤ 0.05.

Conclusion: Severe measles infections are prevalent among unvaccinated children due to their susceptibility to complications such as pneumonia and encephalitis. Vaccination remains the most effective measure to prevent measles outbreaks and safeguard public health.

Causes, Morbidity, and Mortality of Upper Gastrointestinal Bleeding Among Hospitalized Patients

Naseeb-ur -Rehman — 2024-07-03

Abstract

Background: The most common, potentially fatal emergency that brings patients to the hospital is upper gastrointestinal bleeding/hemorrhage.

Objective: To assess the causes, morbidity, and mortality of upper gastrointestinal bleeding among hospitalized patients

Material and Methods: This descriptive study was carried out at the medical unit of DHQ hospital D I Khan. The duration of the study was six months from January 2023 to June 2023. Upper gastro intestinal endoscopies were carried out for all the enrolled patients by experienced endoscopists after initial all the patients were hemodynamically stabilized. All the data was collected by using a Proforma designed for this research. The Rockall score for each patient was then obtained using the whole multivariate analysis. SPSS 24.0 was used to analyze the collected data.

Results: In the current research, totally 220 patients were selected. The male patients in our study were 143 (65%) while the female patients were 77 (35%). Based on endoscopy, the commonest cause of upper GI bleeding was esophageal varices in 132 (60%), followed by peptic ulcer in 33 (15%), gastritis in 22 (10%), esophagi is in 20 (9.09%). The overall mortality rate in our study was 13 (5.91%). A significant association was observed between Rockall score and mortality (p=0.001).

Conclusion: Our study concludes that variceal bleeding was the commonest cause of upper gastro-intestinal bleeding. Peptic ulcer was the second most common cause of upper gastro-intestinal bleeding. Our study also shows that Rockall score is a good predictor of outcome in upper GI bleeding patients.

Comparison of Maternal Complications of Emergency vs Elective Caesarean Section for Placenta Previa

Wagma Haq — 2024-07-02

Background: Placenta previa, being an obstetric emergency, is managed via either emergency or elective cesarean section depending upon clinical presentation of women. Multiple maternal and neonatal complications are associated with cesarean section varying with type of cesarean section.

Objective: The study was designed to evaluate maternal complications of emergency vs elective cesarean section for placenta previa.

Material and Methods: This cohort study was conducted in Gynecology and Obstetrics Department, Lady Reading Hospital Peshawar after obtaining ethical approval from the Institutional Review Board in January 2024 till required sample size achieved April 2024. About 95 women with singleton pregnancy undergoing cesarean section (emergency or elective Cesarean section for placenta previa, with any maternal age included. Women were divided into two groups, emergency cesarean section (group 1) and elective cesarean (group 2).Maternal complications including post-partum hemorrhage (PPH),need for blood transfusion, post-operative fever and wound infection were recorded.

Results: The study showed mean age of 29.1±6.2 and 29.6±6.4 years for Group 1 and Group 2 respectively. Statistically significant differences were found between emergency cesarean and elective cesarean section groups with respect to postpartum hemorrhage (47.9% vs 17% (P = 0.01), need for blood transfusion 91.6% vs 17% (P = 0.000),and postoperative fever (47.9% vs 12.7% (P = 0.001), while non significant difference observed for wound infection (4.1% vs 2.1% P=0.19).

Conclusion: Many maternal complications like postpartum hemorrhage, blood transfusion and postoperative fever were significantly higher in emergency cesarean compared to elective cesarean group for placenta previa.

Incidence and Characteristics of Scaphoid Fractures in the Adult Population of D.I.Khan, Pakistan

Ihsanullah Nasir — 2024-07-03

ABSTRACT

Background: Scaphoid fractures pose significant challenges due to their unique anatomical characteristics and potential complications. This study aims to investigate the incidence and characteristics of scaphoid fractures in the adult population of D.I.Khan, Pakistan.

Objective: To determine the incidence and characteristics of saphead fractures in the adult population of D.I.Khan, Pakistan.

Material and Method: This cross-sectional study was conducted at Department of Orthopedics, DHQ Teaching Hospital, D.I.Khan, Pakistan from January 2022 to December 2023. Sample size was 63. All adult patients (17-50 years old) with saphead fractures were included, excluding old fractures (duration >1 year), open or associated with other injuries. Demographic variables were gender, age groups and presentation time. Research variables were mechanism of injury, laterality, site, treatment modalities, union time and presence of infection.

Results: Out of 63nscaphoid fractures, the prevalence was higher in males 54(85.7%),age group 17-30 years 39(61.9%), presentation time in ≤1week 30(47.6%), mechanism of injury as fall on outstretched hand 42(66.7%), laterality as right hand 45(71.4%), site of fracture as waist 39(61.9%), treatment modalities as ORIF with dorsal approach 23(36.5%).

Conclusion: Early recognition, accurate diagnosis, and tailored management approaches are necessary for optimal caretopreventlong- term complication of saphead fractures which are common in younger males, mostly caused by fallonout stretched hand, and mostly involve righth and waist. Significant number of cases requires sopenr eduction and internal fixation.Unionisachievedmostlyin3-6months.

Prevalence of Pre-Extensively Drug Resistant Tuberculosis, Extensively Drug Resistant Tuberculosis among the Multi Drug Resistant Tuberculosis Patients

Salman khan — 2024-07-03

Abstract

Background: Multidrug-resistant tuberculosis (MDRTB) is a growing global health concern that is a chronic danger to world health due to tuberculosis (TB).

Objective: The aim of this study was to examine the frequency of both pre extensively drug-resistant tuberculosis (PXDRTB) and extensively drug-resistant tuberculosis (EXDRTB) in patients with multidrug-resistant tuberculosis (MDRTB).

Material and Method: A prospective study was performed at DHQ Teaching Hospital, Gomal Medical College, Dera Ismail Khan from March 2023 to February 2024. A cohort of 220 eligible patients with drug-resistant TB, aged 20 to 70, participated. Inclusion and exclusion criteria were applied, and patient profiles and drug susceptibility testing were obtained. Data analysis was conducted using SPSS 27.

Results: Of the total patients, 32.72% (n=72) had PXDRTB, and 8.18% (n=18) had EXDRTB. All PXDRTB cases showed resistant to fluoroquinolone (FQ).

Conclusion: In order to lessen the effect of drug-resistant tuberculosis on public health, tailored treatments and ethical antibiotic usage are important. This is highlighted by the high incidence of FQ resistance. These results have consequences for the early detection, management, and avoidance of tuberculosis that is resistant to drugs.

Revitalizing Lower Motor Neurons Function: Role of Pirfenidone in Recovery of Post-Compression Spinal Cord Injury

Noman Ullah Wazir — 2024-07-03

ABSTRACT

Background: Spinal cord compression injury can cause severe motor deficits and significantly reduce quality of life and Effective motor recovery therapies are limited. This article examines the latest research on pirfenidone potential to enhance motor recovery in SCCI and transform therapeutic approaches.

Objective: The aim of study was to establish whether pirfenidone delivered intraperitoneally can improve lower motor neuron activity in rats following compression injury to spinal cord or otherwise.

Material and Method: This experimental study was carried out at the Institute of Basic Medical Sciences, Khyber Medical University, Peshawar, Pakistan, from September 2021 to December 2022. Induction of injury to T7 spinal cord level was performed by 70gm force aneurysm clip on rats. The group “A” was given a placebo daily, the group “B” was given 200 mg/kg/day daily dose of pirfenidone, and the group “C” was given a daily dose of pirfenidone 500 mg/kg/day. Using 14 & 28 day experimental durations, sub-grouping of all 3 groups was done into groups 1 & 2 (each sub-group having 5 rats). On the final day of the experiment, BBB scoring was conducted to assess lower motor neuron activity in the hind limbs of all rats.

Results: The BBB (Basso, Beattie, Brenham) scores were statistically different between and within groups. The spinal cord injury (SCI) groups that received pirfenidone treatment exhibited higher BBB scores in comparison to the SCI groups that did not receive pirfenidone. The 500 mg/kg/day and a 28-day period of pirfenidone were more effective in improving motor recovery after spinal cord injury than 200 mg/kg/day for a 14-day period.

Conclusion: Pirfenidone is likely to enhance motor functions, contributing to improved functional neurological recovery following spinal cord injury.

Pattern of Junk Food consumption Among Hostelite and Day Scholar Medical Students of Peshawar

Bashir Ahmad — 2024-07-03

Abstract

Background: Junk foods are considered to have low nutritional value, however, young people, especially students are particularly more attracted, because of its more readily available food options..

Objectives: This study aimed to explore the frequency of junk food consumption among undergraduate medical students in Peshawar and analyze the difference among Hostelite and day scholar medical students as well as to determine the factors responsible for it.

Material and Methods: In this cross-sectional analytical study data was collected from 207 MBBS students from five different medical colleges in Peshawar, Khyber Pakhtunkhwa. Random sampling technique was used to collect the data from January to July 2023. A structured questionnaire was used to interview the students about various aspects of their junk food consumption and results obtained were statistically analyzed for level of significance.

Results: The results showed that weekly consumption (n=102, 49.3%) of junk food was the highest. Fast foods (50.5%) and snacks (27.1%) were the most consumed junk foods. The biggest reason for junk food consumption was ‘taste’ (n=178 62.7%). Gender showed a significant association (p<0.05) with increasing frequency of junk food with females consuming more. Differences in residential status and institution classes were not statistically significant effect (p>0.05). Comparison of Hostelite and day scholars for various factors like ‘taste’, ‘convenience’, affordability, social and ‘peer pressure’, ‘craving’ and ‘availability’ did not yield a significant difference either (p>0.05).

Conclusions: We concluded that the most commonly consumed junk food among medical students is ‘fast food’, citing ‘taste’ as the biggest reason. Availability affordability and other factors do not contribute as much. Both, Hostelite and day scholar medical students consume junk food at an equal rate. Females were found to have higher consumption as compared to male students.

Efficacy of Balloon Tamponade in the Management Primary Postpartum Haemmorhage

Maimoona Qadir — 2024-07-03

ABSTRACT

Background: Postpartum Haemmorhage is the leading cause of maternal death all over the world. It remains a serious complication of childbirth in developed and developing countries.

Objective: To evaluate the success of uterine balloon tamponade in those patients suffering from postpartum Haemmorhage where medical treatment has failed.

Materials and Methods: This study was conducted in Gynae Department of Khyber Teaching Hospital, Peshawar from 1st January 2022 to 31st December 2022.Cross sectional is the type of study design and no probability sampling is the type of sampling method. All patients with primary postpartum Haemmorhage, in 15-45 years age range, who delivered vaginally after a full term pregnancy, were included. Those having history of caesarean section, uterine anomalies, preterm labor, morbidly adherent placentas, placental abruptions, placenta previas and retained products were excluded. All the patients where the cause of PPH was uterine atony were first managed with pharmacological treatment, which if failed then uterine balloon tamponade was inserted. Tamponade was removed after 24-48 hours. Failure in cessation of bleeding was followed by surgical management in the form of B lynch suture or hysterectomy. Data was collected in a predesigned Proforma.

Results: The mean age was 26.02+4.42 years.9.72% women had past history of PPH. Majority of our study population was grand Multigravidas(61.57%) and the most prevalent age group was 26-35 years age group.87% women responded to medical treatment and UBT was applied in the rest. The UBT success rate was 89.2% whereas it failed in 10.8% women where laprotomies were conducted. The higher response rate was noticed in grand Multigravidas (50%) and in 26-35 years age group (46%).It failed in three patients who had no history of PPH and was successful in those with coagulopathies.

Conclusion: The response rate to uterine balloon tamponade is higher in patients with postpartum Haemmorhage due to uterine atony. Before embarking on surgical procedures with many possible complications, uterine balloon tamponade should be used

Comparison of Perinatal Outcomes of two Methods to Assist Delivery for Impacted Fetal Head at Cesarean Birth

Nazia Liaqat — 2024-07-03

ABSTRACT:

Background: Impacted fetal head is a challenging obstetrical situation at second stage cesarean births. Among different techniques, Reverse breech extraction and conventional head push techniques are the two widely used techniques.

Objective: To compare perinatal outcomes of breech extraction method Vs head push technique to assist delivery for impacted fetal head at cesarean birth

Material and Methods: This comparative cross-sectional study was conducted in the Gynea Department, Lady Reading Teaching Hospital, Peshawar, from 1st Feb 2019 till 31 Jan 2022. A total of 170, patients with alive fetus, cephalic presentation, undergoing second stage cesarean sections with deeply impacted fetal head and with baby delivered either via push up technique or reverse breech extraction technique were included in the study. Patients were divided in to two equal groups based on the technique of fetal delivery. The two groups were compared for perinatal outcomes of Low APGAR score, NICU admissions and early neonatal deaths.

Results: Of the total 170 patients, 85 were in each group. Mean age was 29.66±4.41, with range from 18 to 40 years. Sixty-one (61%) percent women were multiparas and 39% were primiparas. Mean gestational age of study participants was 39.42 ± 1.37. Statistically significant difference was observed between Group II (reverse breech extraction) and Group I (standard head push) for low APGAR score (<7/10) at 5 minutes i.e. 13 (13.29%) vs 26 (30.59%) (p-0.018). Neonatal intensive care admission rate was 24 % for Group II and 38% for Group I (p-0.066).The difference in neonatal death between two groups was not statistically significant, i.e. 4% vs 6% (p-0.77).

Conclusion: Reverse breech extraction technique has the advantage over conventional head push technique in term of reduced rates of low APGAR scores at 5 minutes of birth

Frequency and determinants of Respiratory Failure in Acute Exacerbation of Chronic Obstructive Pulmonary Disease Patients: A Cross-Sectional Study

Naveed Pervez — 2024-07-03

Abstract

Background: Chronic obstructive pulmonary disease (COPD) is slowly and progressive disorder that is characterized by a permanent or partially reversible obstruction of airflow. A COPD exacerbation can have a variety of clinical outcomes, from self-limited sickness to progressive respiratory failure.

Objective: To determine the prevalence and factors associated with respiratory failure among patients experiencing acute exacerbation of chronic obstructive pulmonary disease (COPD).

Objective: The study was designed to evaluate maternal complications of emergency vs elective cesarean section for placenta previa.

Material and Methods: This cross-sectional study was conducted at the Department of Pulmonology in KhalifaGul Nawaz (KGN), MTI Bannu from January 2022 to December 2022, following approval from the institutional ethical committee. A total of 385 participants were enrolled in this study. Following the documentation of the physical examination and clinical history, various demographic details were noted. The data was analyzed through SPSS Version 25.0.

Results: A total of 385 patients presented with acute exacerbation of COPD were assessed. Out of which 258 were males (67%) and 127(32.9%) were females. In an acute exacerbation of COPD, the number of individuals presenting with respiratory failure was 138 (35.8%). out of which 91(23.6%) were males and 47(12.2%) were females. The age group of 51 to 60 years old had the highest number of individuals experiencing respiratory failure, which were 69 (17.9%).

Conclusion: : In the current study the frequency of respiratory failure in the participants presented with acute exacerbation was high. It is crucial to create efficient plans for stopping smoking and preventing COPD exacerbations in light of its effect on health care resources

An Autopsy-Based Retrospective Analysis of Asphyxia-Related Deaths

Farzand Iqbal — 2024-07-02

Abstract:

Background: In forensic medicine, autopsy is done to find out the cause of death. Among them one of the most important cause of death is asphyxia. Asphyxia is a condition in which the level of oxygen is decreased and ultimately carbon dioxide increased in the body. Prevalence of asphyxia related deaths were studied in relation to different variables like age, gender, region (urban and rural) along with different types of asphyxia.

Objective: To find the frequency of asphyxial deaths in relation to age and gender as well as to investigate the cause and manner of such deaths.

Material and Methods: Retrospective Cross-sectional study carried out in the Department of Forensic Medicine Mekran Medical College Turbat, from July 1, 2019 to June 30, 2023. All the subjects who died due to asphyxia presented for autopsy at the mortuary were included in the study. There were no age or gender restrictions, but participants whose deaths were caused by other causes were not included in the study. Incomplete cases and referrals from other districts were excluded. The pre-designed Performa had a demographic component and closed-ended questions regarding autopsy cases.SPSS v.20 was used for analysis. Categorical variables were analyzed descriptively in the form of frequency and percentages.

Abstract:

Objective: To find the frequency of asphyxial deaths in relation to age and gender as well as to investigate the cause and manner of such deaths.

Results: Our study included 120 subjects; 29.16% were female and 70.83% were male. In the 16–30 age group, 67 cases were reported, while 29 were reported in the 31–45 age group. Urban regions accounted for 61.66% (n=74), while rural areas accounted for 38.33% (n=46).73 cases were from mechanical asphyxia followed by 33 cases of traumatic asphyxia. Regarding the manner of death, hanging is more prevalent than drowning and strangulation.

Conclusion: Asphyxia was the leading cause of death for middle-aged men.The number of deaths caused by asphyxia was higher in urban regions compared to rural ones. Mechanical asphyxia was the most prevalent form of the condition. Hanging was the most common pattern of asphyxia death than drowning and strangulation.

hanical asphyxia followed by 33 cases of traumatic asphyxia. Regarding the manner of death, hanging is more prevalent than drowning and strangulation.

Assessment of the Knowledge and Vaccination Status of Hepatitis B Among High School Students In Sagnarigu District, Ghana

Julius Caesar Mahama — 2024-07-02

Background: According to a 2015 WHO report, 5-10% of adults in Sub-Saharan Africa are chronically infected with the Hepatitis B virus.

Objective: The study sought to assess the knowledge of HBV infection, its mode of transmission, and the attitude towards its vaccination among high school students in the Sagnarigu district of the Northern Region.

Material and Methods: In this descriptive cross-sectional survey, a purposive sampling technique was used to select the schools out of the lot found in the district due to their locations, populations, and varying social status of students in those schools, and simple random sampling was used to select respondents from March to July 2017 in the Sagnarigu district of the Northern Region of Ghana. An anonymous questionnaire was designed for the study based on the research objectives and this was used in the collection of data. The results obtained were presented in the form of tables & graphs and were analyzed statistically.

Results: The study revealed that a significant proportion of the respondents, specifically 343 individuals (92.2%), were aware of HBV infection, and many of them possessed adequate knowledge about the infection. In terms of transmission, 198 individuals (53.2%) correctly identified sexual intercourse as a mode of transmission, while 257 individuals (69.1%) were aware that sharing toothbrushes with an infected person could lead to transmission. vaccination, with 210 individuals (56.5%) expressing willingness to receive the vaccination. However, the actual vaccination rate was relatively low, with only 90 individuals (24.2%) reporting that they had received the vaccination.

Conclusion: There is an urgent need to increase student vaccination rates and raise awareness about HBV infection. We recommend that second-cycle students be vaccinated and educated at the time of admission to help reduce the spread of the infection and raise awareness.